Multiple Cavernous Hemangiomas Presenting as Orbital Apex Syndrome

Abstract

A 41-year-old man presented with a 7-year history of gradually increasing right proptosis and a 2-year history of decreased vision and limited eye movements. Right proptosis (11 mm), limitation of movement in all gazes, anisocoria, and visual impairment implied orbital apex compression. Computed tomography showed several distinct lesions with mild delayed enhancement extending to the orbital apex. Through a lateral orbitotomy, 10 discrete hemangiomas were removed uneventfully. Histopathologic findings were consistent with cavernous hemangioma in all tumors removed. Proptosis resolved after surgery at 3 to 4 weeks. Visual acuity was unchanged (20/25), and eye movement significantly improved at last follow-up, 15 months after surgery.

Multiple cavernous hemangiomas in the orbit

“…To our knowledge, only 15 cases of multiple cavernous hemangiomas occurring within the same orbit have been reported (summarized in Table 1 ). [ 2 , 3 , 5 – 17 ] Among those cases, one was that of bilateral intraorbital hemangiomas with two tumors in the right orbit and three tumors in the left orbit. Twelve patients were female, and three were male.…”

“…[ 1 ] Patients present most commonly with slowly progressive painless proptosis and vision impairment to complete blindness if the lesions are located at a deeper position or have damaged the surrounding tissues, such as the optic nerve. [ 2 ] Radiological examinations, such as computerized tomography (CT) and magnetic resonance imaging, have a fundamental role in its diagnosis. Most of the tumors are unilateral or solitary, and multiple or bilateral lesions within the orbit are rarely reported.…”

Orbital Apex Syndrome: A Rare Form of Ophthalmic Zona: Case Report

“…Bu arada orbita veya kavernöz sinüs benin veya malin tümörleri, anevrizma ve hemanjiyomları da unutulmamalıdır. 1,3,4,[7][8][9][10][11][12][13][14][27][28][29] Çocuklarda rabdomiyosarkom, nöroblastom ve retinoblastomun orbita metastazları en sık nedenler arasındadır. 4 Orbital apeks sendromunun etiyolojisinde enfeksiyon etkenlerine de sık rastlanır.…”

Resolution of Brachial Plexus Palsy Due to Hemangioma After Intravenous Corticosteroid Therapy

“…Previously reported soft tissue hemangiomas have involved cranial nerves II, III, IV, VI, and VII; the lumbar and brachial plexuses; C6 and C7 spinal nerves; and the median, sciatic, tibial, ulnar, and posterior interosseous nerves. [1][2][3][4][5][6][7][8][9] Treatment options for cavernous hemangiomas involving peripheral nervous system structures include observation, systemic or intralesional corticosteroids, interferon α-2A and interferon α-2B, vincristine, cyclophosphamide, and surgical excision. 10 We report a neonate with a large cavernous hemangioma involving the neck who developed brachial plexus palsy shortly after birth and discuss her treatment.…”